Primary Spinal Cord Melanoma: A Case Report and a Systemic Review of Overall Survival

Zhang, Mingzhe; Liu, Raynald; Xiang, Yang; Mao, Jianhui; Li, Guangjie; Ma, Ronghua; Sun, Zhaosheng

doi:10.1016/j.wneu.2018.03.169

Cited by 15 publications

(35 citation statements)

References 47 publications

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“…The most common presenting symptoms of spinal cord melanomas are the gradual onset of lower extremity weakness and paresthesia, but abnormal reflexes, sphincter incontinence, and pain can also occur. 4,8,10 Hydrocephalus and/or signs of increased intracranial pressure, secondary to impaired cerebrospinal fluid circulation and absorption, may indicate leptomeningeal dissemination. 12 Radiological features of primary CNS melanoma depend on the degree of melanocytic content and the presence or absence of hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Primary intramedullary malignant melanoma: can imaging lead to the correct diagnosis?

2020

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Melanoma is a malignant neoplasm of melanin-producing cells. Melanoma usually occurs in the skin, but can also arise in any anatomical site that contains melanocytes, such as mucous membranes, the eyes, and the central nervous system (CNS). Primary CNS malignant melanoma most often develops in the leptomeninges. We report a case of a rare intramedullary melanoma of the thoracic spinal cord. A 78-year-old man was treated with surgery, radiotherapy, and immunotherapy for leptomeningeal spread. We also discuss the role of imaging methods in diagnosis and follow-up. Medullary melanoma occurs more frequently in adults. The most common presenting symptoms are the insidious onset of lower extremity weakness and paresthesia. Magnetic resonance imaging is the method of choice for evaluation. Although there are no imaging features to accurately distinguish primary malignant melanoma from other melanocytic or hemorrhagic tumors, hyperintensity on T1-weighted magnetic resonance imaging should lead to inclusion of this neoplasm in differential diagnosis of spinal cord tumors. Positron emission tomography-computed tomography is a useful auxiliary examination to evaluate the extent of local and metastatic disease. Surgical resection is the primary treatment for intramedullary melanoma. However, the efficacy of adjunctive radiotherapy and chemotherapy for primary spinal cord malignant melanoma is still controversial.

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Section: Discussionmentioning

confidence: 99%

Primary intramedullary malignant melanoma: can imaging lead to the correct diagnosis?

2020

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“…Primary intramedullary spinal melanoma is very rare and unpredictable pathology and surgery remains the first choice of treatment with gross total resection utilizing microsurgical techniques and intraoperative monitoring. [ 3 , 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…Primary CNS melanoma is rare and accounts for only 1% of all melanomas according to the World Health Organization classification. [ 1 , 8 ] Primary intramedullary melanoma are even less frequently encountered, and there are only a few such cases in the literature. [ 3 , 8 ]…”

Section: Introductionmentioning

confidence: 99%

An uncommon intramedullary tumor: Primary medullary cone melanoma

Nogueira

Cardoso

Fonseca

et al. 2020

Surgical Neurology International

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Background: Melanoma is the third most common primary tumor to metastasize to the central nervous system (CNS). However, primary CNS melanoma is very rare, and primary intramedullary melanoma is even less frequently encountered, with only 27 cases published in the literature. There are no pathognomonic imaging characteristics, therefore, the diagnosis must be confirmed immunohistologically and the preferred treatment is the gross total resection. Case Description: A 68-year-old male presented with low back pain of 2 months duration, and 1 week of urinary retention/anal sphincter incontinence. The neurologic examination revealed bilateral paraparesis (3/5 level) with bilateral Babinski signs, and a T10–T11 pin level. The lumbar CT-Scan showed a hyperdense intramedullary tumor arising from the conus medullaris. The patient underwent a D12–L2 laminectomy with myelotomy for gross-total tumor resection. Postoperatively, he regained motor function but the urinary incontinence remained unchanged. The diagnosis of a primary malignant melanoma was confirmed both histopathologically and immunohistochemically (e.g., staining revealed positive immunoreactivity for S100 protein and Melan A). Conclusions: Primary intramedullary spinal melanoma is very rare, and the diagnosis must be biopsy/operatively confirmed. Whether gross total resection is feasible depends on the extent of tumor infiltration of the cord/ adherence as well as the potential for clinical deterioration with overly aggressive removal.

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“…7 According to a retrospective study, the 12-month survival was 89.6% and the 72-month survival was 39.6%. 6 This report underlines the importance of a comprehensive diagnostic approach involving imaging with spine MRI, wholebody CT and PET, detailed histopathological examination, and thorough gastrointestinal, ophthalmologic, dermatologic, and gynecologic evaluation to determine whether the melanoma is metastatic to the spine or primary spinal melanoma. This distinction is of paramount importance as primary lesions are associated with better outcomes following early surgical intervention and, controversially, adjuvant chemoradiotherapy.…”

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confidence: 95%

“…Some studies credit a multidisciplinary approach involving chemo and radiotherapy, 2 whereas others demonstrate no survival benefit, but possible decrease in risk of metastasis. 6 Survival outcomes vary dramatically from 3 months to 21 years, and late recurrences have been reported. 7 According to a retrospective study, the 12-month survival was 89.6% and the 72-month survival was 39.6%.…”

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confidence: 99%